Is laser conditioning a valid alternative to conventional etching for aesthetic brackets?

ER:Yag lasers have been described as a more conservative alternative to conventional acid-etching enamel conditioning technique, when bonding conventional metallic orthodontic brackets. Since the use of aesthetic orthodontic brackets is constantly increasing, the purpose of the present report has been to test laser conditioning with different aesthetic brackets.

Study Design: Five different aesthetic brackets (microfilled copolymer, glass fiber, sapphire, polyoxymethylene and sintered ceramic) were tested for shear bond strength and Adhesive Remnant Index scores using two different enamel conditioning techniques (acid etching and ER:Yag laser application). Two hundred bovine incisors were extracted, cleaned and embedded in resin. Specimens were then divided into 10 groups with random tables. Half of the specimens were conditioned with conventional orthophosphoric acid gel, the other half with ER:Yag laser. Different aesthetic brackets (microfilled copolymer, glass fiber, sapphire, polyoxymethylene and sintered ceramic) were then bonded to the teeth. Subsequently all groups were tested in shear mode with a Universal Testing Machine. Shear bond strength values and adhesive remnant index scores were recorded. Statistical analysis was performed.

When considering conventional acid etching technique, sapphire, polyoxymethylene and sintered ceramic brackets exhibited the highest SBS values. Lowest values were reported for microfilled copolymer and glass fiber appliances. A significant decrease in SBS values after laser conditioning was reported for sapphire, polyoxymethylene and sintered ceramic brackets, whereas no significant difference was reported for microfilled copolymer and glass fiber brackets. Significant differences in ARI scores were also reported.

Laser etching can significantly reduce bonding efficacy of sapphire, polyoxymethylene and sintered ceramic brackets.